肝移植患者术后高血压的病因分析与治疗  

Etiological analysis and therapies of hypertension in patients after liver transplantation

作　　者：雷建卫[1] 曾强[1] 窦剑[1] 高庆军[1] 王洋[1] 史艳敏[1] 

机构地区：[1]河北医科大学第三医院肝胆外科,石家庄050051

出　　处：《器官移植》2012年第6期316-319,328,共5页Organ Transplantation

摘　　要：目的分析肝移植患者术后早期高血压的病因及治疗方法。方法研究对象为2002年8月至2012年4月在河北医科大学第三医院进行肝移植的终末期肝病患者,术后随访1个月以上,排除术前高血压者,纳入研究共102例。其中男性90例,女性12例,年龄(51±9)岁。按术后1个月随访结果,连续3次血压测定收缩压≥140mmHg(10mmHg=1.33kPa)和(或)舒张压≥90mmHg确诊为高血压,将102例患者分为高血压组(40例)和正常血压组(62例)。对两组患者的临床资料进行回顾性分析,统计肝移植术后高血压的发生率,按术前不同肝功能分级比较术后高血压发生率的差异,比较两组患者术中及术后3d的液体出入量,了解高血压组患者肝移植手术前后的各项指标变化,包括血压、中心静脉压和空腹血糖,分析高血压组治疗经过及预后。结果 40例术后发生高血压,发生率为39.2%,其中肝功能Child-Pugh分级为B级和C级的患者,术后高血压发生率明显高于A级的患者。与肝移植手术前相比,术后3d、7d、14d、21d的收缩压与舒张压、空腹血糖及中心静脉压均显著增高(P<0.05或P<0.01)。肝移植术后高血压患者的术中及术后3d液体出入量明显高于正常组(均为P<0.05)。高血压组40例患者中,16例仅给予减少液体入量后即缓解,8例短期给予口服硝苯地平、7例静脉滴注硝普钠后血压降至正常,另有9例患者高血压持续存在,需长期口服降压药。结论肝移植患者术后早期高血压发生率较高。肝移植术后高血压的发生与术前肝功能Child-Pugh分级、液体管理及术后高血糖有关。治疗措施包括减少液体入量、给予降压药物控制血压与降血糖治疗等,经治疗多数患者血压可恢复正常。Objective To analyze the etiopathogenisis and therapies of early hypertension in patients after liver transplantation. Methods One-hundred and two end-stage patients, preoperative hypertension excluded, who underwent liver transplantation in the Third Hospital of Hebei Medical University from August 2002 to April 2012, were enrolled in the study. All the patients received one month of postoperative follow-up and were at the age of 51±9, of whom 90 were male and 12 were female. According to the results of one month postoperative follow-up, if 3 consecutive measures of contractive pressure were ≥ 140 mmHg （ 10 mmHg = 1.33 kPa） and/or diastolic pressure were ≥90 mmHg, the patients were diagnosed with hypertension. The patients were divided into hypertension group （ n = 40） and normal blood pressure group （ n = 62 ）. The retrospective analysis of clinical data of two groups was performed. The incidence rate of hypertension in patients after liver transplantation was calculated and the differences of the incidence rate of hypertension between the two groups were compared according to the preoperative liver function grade. The differences of intake and output fluid volume during operation and 3 days after operation between two groups were compared. The changes in indexes including blood pressure, central venous pressure and fasting blood glucose of hypertension group before and after operation were observed and the treatment and prognosis were analyzed.Results Forty cases suffered from hypertension after liver transplantation and the incidence rate was 39.2%. The incidence rate of hypertension in patients with Child-Pugh B and C was apparently higher than that in patients with Child-Pugh A after liver transplantation. Compared with those before liver transplantation, the contractive pressure and diastolic pressure, central venous pressure and fasting blood glucose of 3, 7, 14, 21 d increased significantly after liver transplantation （P 〈 0. 05 or P 〈 0. 01 ）. The intake and output fluid volume

关 键 词：肝移植 高血压 肝功能分级 液体管理 高血糖 

分 类 号：R617[医药卫生—外科学] R544.1[医药卫生—临床医学]